Provider Demographics
NPI:1811754997
Name:SAGE & LORE COUNSELING
Entity type:Organization
Organization Name:SAGE & LORE COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:PETRA
Authorized Official - Middle Name:P
Authorized Official - Last Name:WILKES
Authorized Official - Suffix:
Authorized Official - Credentials:MFT, MHC
Authorized Official - Phone:978-310-1212
Mailing Address - Street 1:4085 HANCOCK BRIDGE PKWY STE 112-116
Mailing Address - Street 2:
Mailing Address - City:NORTH FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33903-7219
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1404 DEL PRADO BLVD S
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33990-3774
Practice Address - Country:US
Practice Address - Phone:978-310-1212
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-05
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health